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PTSD Vet and Family Use Helpful Shared Decision Making Aids

These stories are fictional, but are based on real Veterans' experiences.

Profile: Ms. Williams

Ms. Williams is a 31 year old Operation Iraqi Freedom combat Veteran who served in the Army and suffered blast injuries.

She has difficulty walking, balance problems, and trouble remembering instructions and details.

She has high blood pressure.

She does not feel like her “old” easygoing self, and is now quick to anger and prefers to be alone.

She has been evaluated and found to have Post-Traumatic Stress Disorder.

Ms. Williams' support system:

She lives with her mom and her school-age daughters.

She knows her mom is worried that she will not be able to provide all of her care.

Ms. Williams and her family were open to considering what services the VA offers that could make some of the challenges at home easier to manage. Home and Community Based Services, known to older Veterans as part of “long term care,” are sometimes called “independent living resources” by younger Veterans. Her nurse care manager showed Ms. Williams the Guide to Long Term Care and suggested she complete the Shared Decision Making Worksheet. The nurse also suggested that Ms. Williams’ mom fill out the Caregiver Self-Assessment, as these shared decision making decision aids work best when used together.

These stories are fictional, but are based on real Veterans' experiences.

Step 1: What were her needs?

Ms. Williams thought about her situation. She thought about what kind of support she will need for day-to-day activities in the months ahead. The first section of the Shared Decision Making Worksheet asked about Ms. Williams’ needs. She thought about what she can do by herself:

She can manage things like cooking, dressing herself, and moving around the house.

She also thought about how her mom and daughters might help her with tasks that are difficult for her.

Her daughters are good on the computer and could help her order prescription refills online.

Her mom could help manage her appointments and finances.

Her mom could probably help most times when she needs to go to appointments.

Her main challenge was making sure her health care needs were met. She jotted down some notes to help organize her thoughts about what matters to her most.

These stories are fictional, but are based on real Veterans' experiences.

Step 2: Explore Options

Ms. Williams looked into services that are available through the VA. By looking at the online Guide to Long Term Care and talking with a VA social worker, she learned about services she could get at home. She was especially interested in details about the Home Telehealth program.

In Step 2, Ms. Williams weighed the pros and cons of the long term care options that she learned about on the website and thought might be the best fit for her. For Telehealth:

Pro: Many of her doctor visits would be eliminated – this would be good because then her mom would not have to take time off of work as much.

Con: She would need help getting to some medical visits.

For Respite Care:

Pro: She would have some company while her mom and her girls were running errands.

Pro: Her mom could get a break.

Con: She may need more than the allotted 30 days per year.

For Homemaker/Home Health Aide:

Pro: She could get some help with tasks at home that her mom can't do while she's at work.

Con: She might feel stressed having someone in her home or be embarrassed about how her home looked on some days.

These stories are fictional, but are based on real Veterans' experiences.

Step 3: Involve Others

After Ms. Williams really thought about what she needed and about the pros and cons of some of the long term care options, she decided to involve her mom in making these important decisions.

She urged her mom to fill out the Caregiver Self-Assessment so they could make realistic decisions and take everyone’s needs into consideration.

Ms. Williams found out more about her mom’s preferences:

Her mom is glad she’s living at her house even if she requires quite a bit of assistance.

Her mom thinks it is very important for her daughter to be at home with her children. Ms. Williams also felt her mom understood that she wants to be as independent as possible and does not want to be a burden on her family.

She decided to talk with her social worker over the phone. She wanted to make sure she had thought about the pros and cons of each long term care service option. The social worker confirmed that she really did qualify to receive more than one service at a time and that a combination of services would be helpful. She also found out that there is no penalty for starting a service and deciding it isn’t working and dropping it or switching to another service.

The other great suggestion from her social worker was to make an appointment with her doctor in the Women’s Clinic to get her doctor’s perspective on her health and care needs and to be sure Home Telehealth was a good choice for her.

Then to complete Step 3, she checked back with her mom and daughters about what tasks they could help with and where they thought gaps existed. She really liked the part of shared decision making where you involve others in planning.

Ms. Williams' Shared Decision Making Worksheet

Ms. Williams' Mom's Caregiver Self-Assessment

These stories are fictional, but are based on real Veterans' experiences.

Step 4: Take Action

Once Ms. Williams had more information from her social worker and was clearer about her mom’s role while the girls are still in school. Ms. Williams reviewed her needs, thought about what is most important to her, identified her options for support and then in Step 4 she planned her next steps.

She will write out questions she still has.

She will make an appointment with her social worker to meet in person so she and her mom can get their last few questions answered. She will take her mom with her because she still has trouble tracking lots of details.

After 1 month: Ms. Williams decided to continue living with her mom and to try using a mix of Telehealth and Respite Care for now and then to re-evaluate in 6 months after everyone has had a chance to see how that combination works for her and her family. She also decided to try to use about half of her allowed respite care days to see if that feels like enough of a break for her mom.